Annual report pursuant to Section 13 and 15(d)

Leases - Additional Information (Details)

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Leases - Additional Information (Details) - USD ($)
 12 Months Ended
Dec. 31, 2019
Dec. 31, 2018
Jan. 01, 2019
Lessee Lease Description [Line Items]      
Operating lease, option to extend options to extend the leases for up to 5 years.    
Operating lease, existence of option to extend [true false] true    
Operating lease right-of-use asset $ 5,855,000   $ 6,418,000
Operating lease, liability 6,716,000   $ 6,418,000
Operating lease cost $ 2,269,000    
Corporate Headquarters in California      
Lessee Lease Description [Line Items]      
Annual percentage increase in rental expense 3.50%    
Lease payments annual increase description Lease payments for its corporate headquarters will increase annually by the lesser of the change, if any, in the Consumer Price Index of the Bureau of Labor Statistics of the U.S. Department of Labor or three and one-half percent (3.5%) at each annual adjustment date thereafter.    
Commercial and Industrial Space In Texas      
Lessee Lease Description [Line Items]      
Annual percentage increase in rental expense 2.50%    
Lease payments annual increase description Lease payments for the Company’s commercial and industrial space in Texas will increase annually by two and one-half percent (2.5%) at each annual adjustment date thereafter.    
MedSupport Systems B.V.      
Lessee Lease Description [Line Items]      
Operating lease cost $ 31,000 $ 33,000  
Minimum      
Lessee Lease Description [Line Items]      
Operating leases, lease term 2 years    
Minimum | Corporate Headquarters in California and Commercial and Industrial Space in Texas      
Lessee Lease Description [Line Items]      
Operating leases, lease term 10 years    
Additional operating lease cost $ 27,215,000    
Maximum      
Lessee Lease Description [Line Items]      
Operating leases, lease term 8 years    
Operating lease option to extend term 5 years    
Maximum | Corporate Headquarters in California and Commercial and Industrial Space in Texas      
Lessee Lease Description [Line Items]      
Operating leases, lease term 11 years